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目的探讨钡餐造影和螺旋CT增强检查对食管癌可切除性的评价。方法 80例行手术切除的食管癌患者术前常规行钡餐造影、螺旋CT增强扫描以判断肿瘤的可切除性,重点评估病变长度、周围侵犯及淋巴结转移,评估可切除性,指导手术方案的制定(经影像学检查不宜手术治疗或需术前放化疗者不在本研究之列)。结果 80例中76例行根治性切除术,3例姑息性切除,1例探查术(外侵严重未切除);术前影像学判断气管支气管受侵12例,符合11例,高估1例;主动脉侵犯13例,符合12例,低估1例;侵犯心包3例,与手术病理符合;术前增强CT诊断淋巴结转移26例58枚,证实21例43枚,术后病理检查淋巴结转移29例97枚,假阳性4例,假阴性3例。结论钡餐造影能反映食管癌整体累及范围及管腔内病变情况,螺旋CT增强扫描能明确肿瘤外侵和转移的情况,二者结合对食管癌的可切除性评估有着重要的临床价值,有助于手术方案的制定。
Objective To evaluate the evaluation of the resectability of esophageal cancer by barium meal angiography and spiral CT enhanced examination. Methods Eighty patients with esophageal cancer who underwent resection were routinely performed barium meal angiography and spiral CT enhanced scan to determine the resectability of the tumor. The length of the lesion, the surrounding invasion and the lymph node metastasis were evaluated. The resectability was evaluated and the surgical plan was formulated (The imaging examination should not be treated surgically or need preoperative radiotherapy and chemotherapy are not in this study). Results Of the 80 cases, 76 cases were treated by radical resection, 3 cases were treated by palliative resection and 1 case by exploratory operation (with serious unresectability); 12 cases were diagnosed as bronchial and bronchial invasion by preoperative imaging, which was consistent with 11 cases and overestimated in 1 case ; Aortic invasion in 13 cases, in line with 12 cases, underestimation in 1 case; invasion of the pericardium in 3 cases, consistent with the surgical pathology; preoperative enhanced CT diagnosis of lymph node metastasis in 58 cases in 58 cases, confirmed in 21 cases of 43 postoperative pathological examination of lymph node metastasis 97 cases, 4 cases of false positive, false negative in 3 cases. Conclusion Barium meal imaging can reflect the overall extent of esophageal cancer and intraluminal lesions, spiral CT enhanced scan can clear the invasion and metastasis of the tumor, the combination of the two esophageal resectability assessment has important clinical value, is helpful In the development of surgical options.